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Dressage at Blue Goose I, II, III
Cochranville. PA
May 13, 2015
Judge:
R Scott Peterson (S –NY)
Louise Cox (R-NC)
Technical Delegate:
Camille Kopcik (R-NY)
Open: March 1
Closes: April 25,
Competition 317167
July 1, 2015
Judge:
Margaret Freeman (S-NC)
TBA “R”
Technical Delegate:
Peter Onoszko (r—WV)
Opens: May 1
Closes: June 20
Competition 317556
August 5, 2015
Judge:
TBA “S”
Nancy Lowey (R-VA)
Technical Delegate:
Michelle King (r-VA)
Opens: June 1
Closes July 25
Competition 327685
2015 USDF/USEF Level 2 Dressage Competitions
Official Qualifying Competitions for:
2015 Great American Insurance Group/USDF Regional Dressage Championships
2015 Colonel Bengt Ljungquist Memorial Championships
2015 Dover/USDF Adult Amateur Medal Program
Secretary/ManagerSecretary/ManagerSecretary/ManagerSecretary/Manager
Darcy Miller
210 White Horse Rd
Cochranville, PA 19330
Information:
610-999-5231
www.BlueGooseStable.com
LicenseeLicenseeLicenseeLicensee
Darcy Miller
Cochranville, PA
Farrier On CallFarrier On CallFarrier On CallFarrier On Call
TBD
Veterinarian On CallVeterinarian On CallVeterinarian On CallVeterinarian On Call
Steve Berkowitz
Unionville Equine Associates
610 –932-6800
EMT on SiteEMT on SiteEMT on SiteEMT on Site
Karen Boland
Intro : $35.00 per test
(note: Intro classes are exempt from all horse ID and membership
requirements and USEF Drug Fee)
Non-Competing Horse Fee:
$40.00 Must submit Completed Entry and negative Coggins.
No USEF / USDF fees apply
Training thru Fourth Level: $45.00 per test USEF Fee: ($8.00 USEF Fee + $8 Drug Fee)$16.00 per horse
FEI Classes: $55.00 per test USEF Show Pass ( If applicable):
$30.00 for each Non-Member rider, owner, or trainer
Musical Freestyles: $60.00 USDF Non-Member Fee ( if applicable):$25.00 for each NM
rider, owner
Pas de Deux : $50.00 per Team USDF Affidavit Fee: $5.00
Should a USDF member not be able to provide any other proof
of membership
Office Fee: Both Fees Non Refundable
$35.00 per entry Online www.Equestrianentries.com
$45.00 per Entry Mailed
GAIG Qualifying Classes: Additional $10.00 per class
Late Fee: $35.00 (for any entry RECEIVED after the closing date) Non – Negotiable Check Fee: $35.00 ( if applicable)
Entry Change Fee:$25.00 if change is possible and before closing
date
FEES:
CLASS LIST
Every class offered herein which is covered by the rules and specifications of the current USEF Rule Book will be conducted and judged in accordance therewith
1. USDF Introductory TOC—Opportunity 15. Fourth Lv. Test 2 BLM
2. Training Lv. Test 1 16. Fourth Lv. Test 3 Q GAIG
3. Training Lv. Test 2 BLM 17. RIDER TESTS TOC
4. Training Lv. Test 3 Q GAIG 18. USDF Musical Freestyle $300 (First—Fourth) BLM QGAIG
5. First Lv. Test 1 19. Pas de Duex BLM
6. First Lv. Test 2 BLM 20. FEI Musical Freestyle BLM QGAIG $300
7. First Lv. Test 3 Q GAIG 21. FEI Prix St. Georges BLM QGAIG
8. Second Lv. Test 1 22. FEI I-I, I-II BLM, GAIGQ
9. Second Lv. Test 2 BLM 23. FEI Grand Prix BLM, GAIGQ
10. Second Lv. Test 3 Q GAIG & Dover Medal 24. FEI TOC (any FEI Test not listed) GIAG Q if applicable
11. Third Lv. Test 1 25. FEI Young Horse TOC
12. Third Lv. Test 2 BLM 26. FEI Para Equestrian MFS TOC
13. Third Lv. Test 3 QGAIG 27. FEI Para Equestrian (20x40 arena)
14. Fourth Lv. Test 1 28. FEI Para Equestrian (20 x 60 arena)
FREESTYLE REQUIREMENTS: Except for USEF/USDF Championship classes and for FEI
Pony Riders, FEI Junior, FEI Young Rider and FEI Para-Equestrian Freestyles, in order to
enter a freestyle class at any level, a horse/rider combination must have received a mini-
mum score of 60% in the highest test of the declared freestyle level or any test of a higher
level at a Federation Licensed Competition held prior to the competition where the horse/
rider combination is entered to ride a freestyle class. A photocopy of the test verifying eligibil-
ity must be submitted with the entry
AWARDS
♦ Ribbons 1st Thru 6th place. All classes will be ranked by rider status (AA and Jr. ranked
together) and pinned separately if there are more then three riders of a certain status in the
class (ie. - three AA/Jr. and one Open - class will be pinned separately). Otherwise the class
will be pinned as scored.
♦ USDF/Dover AA Medal - See USDF.org for Details
♦ $300 Blue Goose Musical Freestyle $300 Blue Goose Musical Freestyle $300 Blue Goose Musical Freestyle $300 Blue Goose Musical Freestyle (classes 18 and 20) Both classes will be
pinned Open / AA / Jr-Yr for ribbons, but combined for prize money. If either
class has fewer than 3 entrants, the two classes will be combined for $300 purse.
If both classes have 3+ entrants, $300 purse for each class. First: $150, Runner-
Up $90, Third: $60. Prize Money Paid to Owner of Record. Must Pick up
checks in Secretary Stand.
ATTENTION COMPETITORS
Each competitor is responsible for supplying management with correct association numbers (USDF, United
States Equestrian Federation) for horse, owner, and rider before the day(s) of the competition. The scores of
competitors who fail to supply correct numbers may not be counted toward national awards.
Motorized Vehicle Statement
In accordance with GR1301.7:
Minors who do not have a valid driver's license which allows them to operate a motorized vehicle in the state in which
they reside will not be permitted to operate a motorized vehicle of any kind, including, but not limited to, golf carts,
motorcycles, scooters, or farm utility vehicles, on the competition grounds of licensed competitions. Minors who have a
valid temporary license may operate the above described motorized vehicles as long as they are accompanied by an
adult with a valid driver's license. Violations of this rule will be cause for sanctions against the parent(s), guardian(s)
and/or trainer(s) who are responsible for the child committing the offense. Penalties may include exclusion of the child,
parent(s), guardian(s), and/or trainer(s) from the competition grounds for the remainder of the competition and charges
being filed against any of the above individuals in accordance with Chapter 6. Wheelchairs and other mobility assis-
tance devices for individuals with disabilities are exempt from this rule.
DEFINITIONS AND ELIGIBILITY:
• BLM: Results of these classes are used to qualify horse and rider combinations for the 2015 Colonel Bengt Ljungquist Memorial Championships. Riders must be a member of a participating GMO. For rules go to www.cblm.org
• GAIG/USDF –Q: If entering a Great American Group /USDF Qualifying class, enclose additional $10 fee. Riders must have
copies of current USEF and USDF participating membership; Owners must have either participating or business USEF and USDF
membership cards and USDF / USEF Horse Registrations must be included with entry.
• Adult Amateur: Adult Amateur entries must include a copy of their current USEF membership card declaring them such.
• JR/YR: Individuals are eligible to enter as Juniors until the end of the calendar year in which they reach the age of 18. Individu-
als are eligible to enter as Young Riders from the beginning of the calendar year in which they reach the age of 16 until the end of
the calendar year in which they reach the age 21. Competitors shall compete as Adults from the beginning of the calendar year in
which they reach age 22. (DR19.3) Riders who are 16 and 17 may compete as either Juniors or Young Riders. Date of Birth must
be noted in designated spot on entry form.
• USDF Horse Numbers: USDF requires all competing horses to have a Horse Identification Number (HID) for the purpose of
tracking scores. A HID can be obtained from USDF online for a fee $25. If your horse is Lifetime Registered that number is your
horse HID. Competitors are strongly urged to acquire this number prior to the competition. Go to www.usdf.org
• USEF Horse Numbers: USEF requires all competing horses to have an Identification number (ID). USEF and USDF have
reached an agreement to share HID/ID numbers. Horses must be fully registered with both the USEF and USDF to be eligible to
participate in the GAIG/USDF-Q classes.
USEF FEES AND REQUIREMENTS:
• USEF membership information for EACH Rider, Owner, Trainer, Horse, Coach ~ if applicable, is required on your entry
form. If an exhibitor does not submit the proper membership documentation to the competition and the competition can not verify
such information, (with the exception of Federation measurement cards), the exhibitor will be responsible to pay a $30 non mem-
ber fee with is non refundable. ( GR 1309, 2.b) • For USEF Non- Members: A Show Pass is required - A $30 fee will be collected
for EACH non-member rider, owner, trainer, coach ~ if applicable.
• USEF HORSE ANNUAL OR LIFETIME REGISTRATION IS REQUIRED FOR QULAIFYING CLASSES.
• The USEF Horse ID or Horse Recording number is required on your entry form. If you do not have a Horse ID, you may apply
for one before the competition www.usef.org , provide your USDF Horse HID number as proof for Horse ID ( GR 1101)
USDF FEES AND REQUIRMENTS:
• The USDF membership information for EACH Rider, Owner, Horse is required on your entry form.
• For each USDF non-member (NM) owner/lessee and USDF NM rider there will be a fee of $25 collected by the competition.
In addition an Affidavit form and $5 affidavit fee will be used for any USDF member not able to provide any other proof of
membership.
• The USDF Horse ID (HID) or Lifetime Registration is required on your entry form. If you do not have a HID or Lifetime Regis-
tration number, you will be required to fill out either a HID form or Lifetime form and pay appropriate fees. If you have a HID or
Lifetime Registration and cannot provide proof , you will be required to fill out an affidavit and pay an additional $5 fee to USDF
before you are allowed to compete. USDF Horse Lifetime Registration is required for Qualifying Classes.
• Horse and riders/owners who are ONLY competing in Intro, Opportunity, Para-Equestrian or Pas de Deux are not required to
have USDF numbers.
Entries must include:
1. 2015 USEF/USDF Region One Entry form only. Must be one page /double sided with original signatures. No
photocopied signatures. FILL OUT ENTRY IN ITS ENTIRETY.
2. $45.00 Office Fee per entry. ($35 if entered though Equestrian entries)
3. $16.00 USEF Federation Fee per entry. ( Includes $8 for Drugs and Medication Fee and $8 Federation fee)
4. Class Fees
5. Negative Coggins dated within one year of the show date. Horse name on the entry blank must match coggins
report and USEF / USDF documentation. USEF GR 907.3
6. Copies of USEF and USDF Membership cards for Rider, Owner, Trainer, Horse, and Coach (if applicable) or USEF/
USDF non member fees. THESE MUST BE INCLUDED WITH YOUR ENTRY! Entry is not valid without them.
7. Include a LEGIBLE e-mail address on entry form. This will be used to send confirmations as well as ride times.
8. Make checks payable to: Blue Goose Stable LLC - Checks returned for insufficient funds will incur a $35 fee. The entry will be
placed on waiting list until another form of payment is secured. No exhibitor is permitted to show until all fees are
paid. Competitors will be subject to USEF Non –negotiable funds Rule (GR 1508.1)
9. REFUNDS: Cancellations and those on the waitlist prior to closing date will be refunded, less office fee. NO REFUNDS
(including overpayments) WILL BE GIVEN AFTER CLOSING DATE FOR ANY REASON. Management reserves the right
to cancel any classes due to hazardous weather, Acts of God, accident, or emergency. Every effort will be made to reschedule with
priority given to Qualifying classes. No REFUNDS for cancellations due to hazardous weather, Acts of GOD, accidents or emer-
gencies.
10. POST ENTIRES: Accepted if space available. A $35.00 additional fee per entry applies.
11. Entries must be RECEIVED BY CLOSING DATE. No telephone, e- mail, or faxed entries will be accepted.
12. Incomplete entries will be placed on wait list until all documents are received.
13. Non Competing Horses: Must submit completed entry form with signatures, a current negative coggins and $40.00 fee prior to
show date.
14. Entry must include EMERGENCY CONTACT NUMBER in the space provided.
MANAGEMENT RESERVES THE RIGHT
TO RETURN ENTRIES THAT ARE
INCOMPLETE OR INACCURATE
BRIDLE NUMBERS MUST BE WORN
AT ALL TIMES ON THE SHOW GROUNDS.
THIS INCLUDES NON-COMPETING HORSES
CONDUCT OF SHOW:
All standard USEF Rules will apply. Please refer to Standard Rules listed in Omnibus or your USEF Rulebook. Show Man-
agement reserves the right to limit entries, add or divide classes, to add or substitute judges, to cancel awards and
prizes and/or make whatever changes are required by circumstances to the competition specifications listed herein.
Show Management reserves the right to cancel classes insufficiently filled and to refuse or require withdrawal of an
entry for cause deemed sufficient by Show Management.
Mind Your Mellon!
Arena Footing and Arenas:
� Competition arenas are Standard Dressage Arena ( 20 x 60 m) with sand and rubber footing.
� Warm Up – Sand
� NO WARM UP or LUNGING in PARKING AREA
� Lunging is permitted in fenced grass paddock marked for lunging.
Times & Office hours :
� The show office will be open at 12:00 noon on Tuesday before the show and at 7 am on show day.
� Phone number during the show 610 – 999– 5231
� Provisional Ride Times will be posted at www.BlueGooseStable.com by Tuesday the week prior to the competition date.
� Official ride times will be posted at 12 noon Tuesday the day before the show. It is the rider’s responsibility to check their offi-
cial ride time for changes upon their arrival at the show.
� Ride times may change up until one hour before the start of the competition. Any and all changes will be posted at the
secretary’s stand.
� Classes may be scheduled out of order.
� Dressage classes must be run in their entirety.
� Failure to enter the arena at your specified time will result in elimination.
Scores: It is the responsibility of the competitor to verify the accuracy of all scores. Scoring errors must be reported to the Show
Secretary within one hour of the official posting of the scores from the last class of the show day.
Foreign Competitors: Non-US citizens and Foreign Competitors must provide proof, in English, of current membership in good
standing in their respective National Federation, or hold a current membership in good standing with USEF.
Protective Headgear : At anytime while mounted on the competition show grounds, all riders under the age 18, all riders while
on horses competing at national level tests, all riders competing in Para-Equestrian test, and all riders while on non-competing
horses, must wear protective headgear as defined by this rule and otherwise in compliance with GR801. When a horse is com-
peting in both national and FEI levels or tests (e.g. Fourth Level and PSG), the rider must wear protective headgear at all times
when mounted on that horse on the competition grounds and during tests. Any rider violating this rule at any time must immedi-
ately be prohibited from further riding until such headgear is properly in place. Any other exhibitor may wear protective head-
gear at any level of competition without penalty from the judge. Protective headgear is defined as a riding helmet which meets
of exceeds ASTM ( American Society for Testing and Materials)/SEI (Safety Equipment Institute) standards for equestrian use
and carriers of the SEI tag. The harness must be secure and properly fitted. (GR120.5)
Hold Harmless Clause:
Understanding that horse sports may be hazardous and dangerous, even leading to permanent injury or death, each owner, rider,
spectator, and other participant assumes any and all risk of loss or injury and agrees to hold harmless, regardless of negligent acts or
omissions Blue Goose Stable, LLC, Alyce & Larry Denver, the show management, show committee, and all horse show personnel.
Other Important Notes:
� Specify on entry form OPEN/AA/Jr/YR. Classes may be split if entries warrant. Adult Amateurs MUST include a copy of
their current USEF Membership card proving AA status.
� Please specify if Qualifying Ride on entry form. Enclose additional $10 fee plus class fee. Rider and Owner must be a
USDF and USEF member; horse must be Lifetime registered with USDF and Annual or Lifetime Registered with USEF.�
Freestyle music must be submitted to Secretary’s office at time of registration for the show. Sound check will take place
during the break prior to the ride. Sound technician will not be responsible for the CD. Please be sure to mark the horse/
rider name on CD. Include a copy of qualifying test with entry
� Dover Medal: Specify Dover Medal AA on entry form. Rider must provide USEF AA membership card and copy of
USDF GMO or Participating membership card. Medal is awarded to the Adult Amateur with the highest score in Class 10
Second Level Test 3, earning a minimum score of 60%.
� No – Shows: If competitor fails to notify the competition secretary of their intention to scratch a test (ie: is a no
show), competition management reserves the right to fill all of that competitors subsequent ride times. USEF Rule 126.1
(3)b
� Test Versions: Current Editions of USDF Intro, USEF Training – Fourth Level and any FEI and Para tests will be used.
� Horse Substitutions: Riders may substitute horses once they have entered only upon presentation of a vet certificate
for the incapacitated horse, or a bill of sale, and ONLY in the classes in which the first horse was entered. The secretary
MUST be notified at least 24 hours prior to the class(es) taking place AND a NEW entry form must be completed prior
and a office fee must be included.
� Class and Judge Changes: Management reserves the right to split, combine, delete, or add classes. Management also
reserves the right to add or substitute judges or make any changes required by circumstances.
� Waiting List: A wait list will be established if necessary and entries will be accepted on a first –come, first serve basis.
� Stabling: None Available.
� Food: Available on grounds
� Sharps containers: A sharps container will be located at the secretary stand. Competition Management may fine any
individual, including trainers, exhibitors, owner, or their agents, up to $100 for improper disposal of needles or other sharp
disposable instruments.
� DOGS: NO DOGS PERMITTED ON THE GROUNDS
� Damages to Third Parties: All owners and competitors are personally responsible for damages to third parties caused
by themselves, their employees, their agents, or their horses. They are therefore strongly advised to take out third party
insurance providing full coverage for participation in equestrian events.
Warning: Under Pennsylvania law an equine professional and equine
activity sponsor is not liable for an injury to or death of a participant in
equine activities resulting from the inherent risks of equine activities.
USEF MEMBERSHIP STATEMENT
Life, senior active and junior active members shall be eligible to participate in all classes at Regular Competitions, Eventing
Competitions at the Preliminary Level or above and Combined Driving Competitions at the Advanced Level, Dressage,
Reining and Vaulting Competitions and Endurance Rides. A nonmember may participate as a handler, rider, driver,
owner, lessee, agent, coach or trainer at Regular Competitions, Eventing Competitions, Dressage Competitions, Reining
Competitions and Combined Driving Competitions upon payment of a $30 Show Pass fee. Participants in the following
classes are exempted from the Requirements of this rule: 1) lead line; 2) exhibitions; 3) games and races; 4) classes for 4-H
members; 5) walk trot and academy classes (academy classes are classes limited to horses used regularly in a lesson pro-
gram); 6) USDF introductory level tests, pas de deux and quadrille classes; 7) NRHA Endorsed Reining Competitions. 8)
Opportunity classes, 9) citizens of other nations who have proof, in English, of current membership in good standing of
their own National Federation, 10) USEA beginner novice division; and 11) assistant handlers in Dressage Sport Horse
Breeding classes.
Sponsorship
It is only through the support of equine-related businesses,
everyone who enjoys showing, and friends that we can hold
recognized shows and offer prize money. Your support is
crucial for the success and continuation of the shows.
We hope that you will consider becoming a sponsor in one or more of these
categories:
Division Sponsor Level: $100.00
Training ____ First ____ Second____ Third ____ Fourth____ FEI____
Adult Amateur Award: $75.00
Blue Goose I ____ Blue Goose II____ Blue Goose III____
Musical Freestyle Challenge : $300
Blue Goose I____ Blue Goose II____ Blue Goose III____
Amount Enclosed:
Name:
Address:
Telephone: Email:
Thank you for your support!
CLASS NO. DIVISION CLASS DESCRIPTION QUAL Y/N FEESRIDER/HANDLER ________________________________________
USEF#______________ USDF#____________ FEI/LOCAL#___________
ADDRESS ________________________________________________
CITY/ST/ZIP______________________________________________
CELL PHONE__________________JR/YOUNG RIDER BIRTHDAY________
EMAIL ADDRESS____________________________________________
RIDER CITIZENSHIP (IF NOT USA )_________________________________
RIDER STATUS (CIRCLE ONE): JR/YG AA OPEN
OWNER ________________________________________________
USEF#______________ USDF#____________ LOCAL# _____________
ADDRESS ________________________________________________
CITY/ST/ZIP ______________________________________________
CELL PHONE______________________________________________
EMAIL ADDRESS____________________________________________
OWNER CITIZENSHIP (IF NOT USA )________________________________
TRAINER _______________________________________________
USEF#______________ USDF#____________ LOCAL# _____________
ADDRESS ________________________________________________
CITY/ST/ZIP ______________________________________________
CELL PHONE______________________________________________
EMAIL ADDRESS____________________________________________
COACH ________________________________________________
USEF#______________ USDF#____________ LOCAL# _____________
ADDRESS ________________________________________________
CITY/ST/ZIP ______________________________________________
Please Fill Out Both Sides of This Form. Reverse side MUST be SIGNED.
2015
COMPETITION NAME____________________________________ COMPETITION DATES
_________________
Official Use OnlyBRIDLE #
NAME OF HORSE PREVIOUS NAME (IF ANY) USEF# USDF# FOR SALE
BREED SEX HEIGHT COLOR COGGINS DATE (ENCLOSED COPY) SIRE DAM
DAM’S SIRE COUNTRY OF BIRTH YEAR OF BIRTH BREEDER FEI/PASSPORT # GROOM
SUBTOTAL CLASS FEES AND QUALIFYING FEES
USEF Show Pass FEES $30 PER NON-MEMBER
USDF NON MEMBER FEE $25 PER NON-MEMBER
OFFICE FEE AND/OR BRIDLE # FEE
USEF HORSE FEES$8 USEF FEE + $8 DRUG FEE = $16.00
CDI HORSE FEES$8 USEF FEE + $ 20 DRUG FEE = $28.00
IHP DISCIPLINE FEE ($35 IF REQUIRED)
STABLING FEES _____ STALL @ $_____/STALL
TACK STALLS _____ STALL @ $_____/STALL
BEDDING ____ BALES @ $_____/BALE
NON COMPETING HORSE FEE
SPONSORSHIP
GROUNDS FEE OR OTHER FEES ___________
OTHER_____________________________
LATE/CHANGE/BANK CHARGES FOR CC
TOTAL FEES
Stabling Information & Special Requests: Please list only ONE name (either individual or barn) for entire group (so we can get everyone together)
Group/Self Tue Wed Thu Fri Sat Sun Mon
Stalls
Tack Stalls
Stable Group: _______________________________________________ Contact: ______________________________
I hereby agree to release, indemnify and hold harmless USDF, its instructors, officers, directors, agents, and volunteers from and against any andall loss, liability or damage arising from or because of, or in connection with, participation in this competition or related activities. I also hereby agree torelease, indemnify and hold harmless the competition liscensee, show management, competition staff, show committee and members, officers,directors, agents, and volunteers from and against any and all loss, liability or damage arising from or because of, or in connection with, participation inthis competition or related activities.
Federation Entry Agreement EffectiveBy entering a Federation-licensed Competition and signing this entry blank as the Owner, Lessee, Trainer, Manager, Agent, Coach, Driver, Rider,
Handler, Vaulter or Longeur and on behalf of myself and my principals, representatives, employees and agents, I agree that I am subject to the Bylawsand Rules of The United States Equestrian Federation, Inc. (the “Federation”) and the local rules of the Competition. I agree to be bound by theBylaws and Rules of the Federation and of the competition. I will accept as final the decision of the Hearing Committee on any question arising underthe Rules, and agree to release and hold harmless the Competition, the Federation, their officials, directors and employees for any action taken underthe Rules. I represent that I am eligible to enter and/or participate under the Rules, and every horse I am entering is eligible as entered. I also agreethat as a condition of and in consideration of acceptance of entry, the Federation and/or the Competition may use or assign photographs, videos,audios, cable-casts, broadcasts, internet, film, new media or other likenesses of me and my horse taken during the course of the Competition for thepromotion, coverage or benefit of the Competition, sport, or the Federation. Those likenesses shall not be used to advertise a product and they maynot be used in such a way as to jeopardize amateur status. I hereby expressly and irrevocably waive and release any rights in connection with suchuse, including any claim to compensation, invasion of privacy, right of publicity, or to misappropriation. The construction and application of Federationrules are governed by the laws of the State of New York, and any action instituted against the Federation must be filed in New York State. SeeGR908.4.
Federation Release, Assumption of Risk, Waiver, and IndemnificationThis document waives important legal rights. Read it carefully before signing.
I AGREE in consideration for my participation in this Competition to the following:I AGREE that “the Federation” and “Competition” as used herein includes the Licensee and Competition Management, as well as all of their
officials, officers, directors, employees, agents, personnel, volunteers and Federation affiliates.I AGREE that I choose to participate voluntarily in the Competition with my horse, as a rider, driver, handler, vaulter, longeur, lessee, owner,
agent, coach, trainer, or as parent or guardian of a junior exhibitor. I am fully aware and acknowledge that horse sports and the Competition involveinherent dangerous risks of accident, loss, and serious bodily injury including broken bones, head injuries, trauma, pain, suffering, or death. (“Harm”).
I AGREE to hold harmless and release the Federation and the Competition from all claims for money damages or otherwise for any Harm to meor my horse and for any Harm of any nature caused by me or my horse to others, even if the Harm arises or results resulted, directly or indirectly, fromthe negligence of the Federation or the Competition.
I AGREE to expressly assume all risks of Harm to me or my horse, including Harm resulting from the negligence of the Federation or theCompetition.
I AGREE to indemnify (that is, to pay any losses, damages, or costs incurred by) the Federation and the Competition and to hold them harmlesswith respect to claims for Harm to me or my horse, and for claims made by others for any Harm caused by me or my horse while at the Competition. Ihave read the Federation Rules about protective equipment, including GR801 and if applicable, EV114, and I understand that I am entitled to wearprotective equipment without penalty, and I acknowledge that the Federation strongly encourages me to do so while WARNING that no protectiveequipment can guard against all injuries. If I am a parent or guardian of a junior exhibitor, I consent to the child’s participation and AGREE to all of theabove provisions and AGREE to assume all of the obligations of this Release on the child’s behalf. I represent that I have the requisite training,coaching and abilities to safely compete in this competition.
I AGREE that if I am injured at this competition, the medical personnel treating my injuries may provide information on my injury and treatment tothe Federation on the official USEF accident/injury report form.
BY SIGNING BELOW, I AGREE to be bound by all applicable Federation Rules and all terms and provisions of this entry blank and all terms and provisions of thisPrize List. If I am signing and submitting this Agreement electronically, I acknowledge that my electronic signature shall have the same validity, forceand effect as if I affixed my signature by my own hand. Copied from USEF website 11/14/2013
RIDER/HANDLER SIGNATURE
(MANDATORY)
PRINT NAME
TRAINER’S SIGNATURE
(MANDATORY)
PRINT NAME
COACH’S SIGNATURE
(IF APPLICABLE)
PRINT NAME
PARENT/GUARDIAN SIGNATURE IF RIDER/DRIVER/TRAINER/HANDLER/VAULTER/LONGEUR IS UNDER 18 PRINT PARENT/GUARDIAN NAME
FILL OUT ONLY IF THE COMPETITION YOU ENTER ON THIS ENTRY FORM OFFERS CERTAIN USE OF CHARGE CARDS!!(Check in the prize list or individual competition requirements)
VISA AMEX CARD NO. _______-___________-__________-_____________ EXP DATE ________
MasterCard Other _____ NAME ON CARD: __________________________________________ CVV # ______
BILLING ADDRESS _______________________________________________________ ZIP CODE _________________
OWNER’S/AGENT’S SIGNATURE
(MANDATORY)
PRINT NAME
RIDER EMERGENCY CONTACT INFORMATION
NAME OF CONTACT/RELATIONSHIP: PHONE:
The United States Equestrian Federation was founded in the spirit of fair play and the safety and well-being of both human and equine athletes in competition. Join 84,000 members who love horses & equestrian sport.
Visit usef.org for more information.
UNITED STATES EQUESTRIAN FEDERATION
shopUSEF.comA fresh approach to classic equestrian style.
Changing the way you look at equestrian sport A fresh approach to classic equestrian style.
The national governing body for equestrian sport The official magazine of the USEF
USEF Competition Name: USEF#:
Competition Division(s) and Rating(s):
Rev Aug 2014
2015 Great American Insurance Group/USDF Regional Dressage Championships
A single Regional Dressage Championship program organized by the United States Dressage Federation (USDF), and recognized by the United States Equestrian Federation, Inc. (USEF), will be held in each of the nine USDF regions. In addition, Alaska and Hawaii may each hold state championships if an official request from a Group Member Organization (GMO) is received by April 1 of the prior year. The Regional Championship Program Rules can be found on the USDF website at www.usdf.org. Please refer to the 2015 USDF Member Guide for the comprehensive list of rules and requirements for this program.
Membership/Registration Requirements for Qualifying and Championships Rider:
Must have a USDF Participating* Membership (PM) at the time qualifying scores are earned and at the time of the championships.
Must have a USEF membership (Junior Active, Senior Active, or Life) at the time the qualifying scores are earned and at the time of the championships.
Horse:
Must have a USDF Lifetime Horse Registration (LTR) at the time qualifying scores are earned and at the time of the championships.
Must have a USEF (Annual or Lifetime) Membership recorded at the time qualifying scores are earned and at the time of the championships.
USDF horse registration and USEF horse/recording must be in the name(s) of the current owner(s) or lessee(s) of record.
A horse is not required to have breed registry papers. Owner:
Must have a USDF membership (PM* or Business Member (BM)) at the time the qualifying scores are earned and at the time of the championships.
Must have a USEF membership (Junior Active, Senior Active, or Life) at the time qualifying scores are earned and at the time of the championships.
* PMs are USDF members who join USDF directly. USDF Group Members (GM) are ineligible. Minimum Qualifying Scores. One set of nationally-standardized qualifying scores has been established for all USEF/USDF Regional Championships, for levels through Grand Prix, in three divisions: open, adult amateur and junior/young rider. FEI Junior and FEI Young Rider classes have only one respective division. Freestyles have only open divisions. The minimum percentages are as follows: OPEN AA JR/YR Training Level (Test 3) 68% 63% 63% First Level (Test 3) 66% 62% 62% Second Level (Test 3) 64% 61% 61% Third Level (Test 3) 62% 60% 60% Fourth Level (Test 3) 62% 60% 60% FEI Junior (Team Test) — — 60% FEI Young Rider (Team Test) — — 60% Prix St. Georges 60% 60% 60% Intermediate I 60% 60% 60% Intermediate II 60% 60% 60% Grand Prix 60% 60% 60% FREESTYLE OPEN AA JR/YR First Level 63% — — Second Level 63% — — Third Level 63% — — Fourth Level 63% — — Intermediate I 63% — — Grand Prix 63% __ __
Competitions/rev. 7/30/2014
2015 USDF/Dover Saddlery Adult Amateur Medal Program The USDF/Dover Saddlery Adult Amateur Medal Program is designed to specifically
recognize and encourage adult amateurs riding at Second Level. Awards 1. USDF/Dover Saddlery Medal Recipient The eligible rider with the highest score of 60 percent or better in the designated Second Level Test Three class or applicable test of choice USDF/Dover Saddlery Adult Amateur Medal class at a participating competition will receive a handcrafted USDF/Dover Saddlery pewter medal and neck ribbon. Winners will receive a $20 Dover Saddlery gift certificate for the first three USDF/Dover Saddlery Medals they win during the competition season. 2. USDF/Dover Saddlery National Merit Award A USDF/Dover Saddlery National Merit Award will be awarded to riders winning three USDF/Dover Saddlery Medals in the same competition year. 3. Year-End Awards The USDF/Dover Saddlery Medal National Champion and Reserve Champion are determined from the average of the top three winning ride scores during the competition year. The champion receives a $1000 Dover Saddlery gift certificate and the reserve champion receives a $500 Dover Saddlery gift certificate.
Rider Eligibility 1. Rider must have a current USDF Participating or Group Membership and be a member in good standing of USDF when the scores are earned.
2. Rider must be an adult amateur in accordance with Article GR1306 of the USEF rules and be designated with USEF as an adult amateur at the time the scores are earned.
Owner & Horse Eligibility 1. Horse and owner must meet minimum competition eligibility requirements at the time scores are earned.
Additional Information For additional information and an updated list of competitions offering the USDF/Dover Saddlery Adult Amateur Medal Program, please visit http://www.usdf.org/awards/performance/adultmedalprogram.asp.
USDF Statement on Animal WelfareThe United States Dressage Federation, Inc. (USDF), a federation of 125 independent organizations throughout the United States with a membership in excess of 30,000 members, supports the concept of ethical treatment of animals.
Dressage is a classical method of training horses, based upon the horse’s natural responses, as carried out in a gradual, planned program during which the horse’s athletic abilities are improved in a systematic manner. As a result, the horse becomes capable, comfortable, and responsive in partnership with the rider without the use of force. Dressage competition at various levels of achievement is the ultimate test of the training program to determine whether the desired harmony between horse and rider has been achieved.
The rules pertaining to dressage competition prohibit the use of artificial appliances, training aids, and drugs, which would force the horse to submit. Instead, the emphasis is upon training and a cooperative partnership with the rider. Major competitions are carefully monitored to assure that there is no unnecessary force or harshness displayed.
Unlike other horse sports in which horses enter training at a relatively immature state, dressage training is usually not seriously begun until the horse is three or four. The top levels of achievement require five or more years of progressive training and it is not unusual to see horses in international competition in their late teens. This, in itself, places a premium on good care and soundness throughout the horse’s life.
While supporting the concept of animal welfare in its broadest form, the United States Dressage Federation, Inc., also recognizes that it is unrealistic to ascribe human emotions and responses to the horse which in its wild state is a creature of flight, living a hard and precarious existence. Under domes-tication, the horse is assured of ample food, water, and shelter, as well as protection against infectious diseases and damaging parasites, thus leading a longer and healthier life with a high rate of survival.
As an educational organization, USDF has numerous programs, which teach people how to pursue the accepted, humane training methods. A program of certifying instructors also emphasizes protecting the horse’s welfare in pursuit of dressage training.
United States Dressage Federation4051 Iron Works Parkway, Lexington, KY 40511
Phone: 859-971-2277, Fax: 859-971-7722, [email protected], www.usdf.org
Each competitor is responsible for supplying manage-ment with correct applicable numbers (USDF and USEF) for horse, owner, rider, and trainer, before the day(s) of the competition.
The scores of competitors who fail to supply correct numbers may not be counted toward national awards.
ATTENTION COMPETITORS
Membership Statement
Life, senior active and junior active members shall be eligible to participate in all classes at
Regular Competitions, Eventing Competitions at the Preliminary Level or above and
Combined Driving Competitions at the Advanced Level, Dressage, Reining and Vaulting
Competitions and Endurance Rides. A nonmember may participate as a handler, rider,
driver, owner, lessee, agent, coach or trainer at Regular Competitions, Eventing
Competitions, Dressage Competitions, Reining Competitions and Combined Driving
Competitions upon payment of a $30 Show Pass fee. Participants in the
following classes are exempted from the Requirements of this rule: 1) leadline; 2)
exhibitions; 3) games and races; 4) classes for 4-H members; 5) walk trot and academy
classes (academy classes are classes limited to horses used regularly in a lesson
program); 6) USDF introductory level tests, pas de deux and quadrille classes; 7) NRHA
Endorsed Reining Competitions. 8) Opportunity classes, 9) citizens of other nations who
have proof, in English, of current membership in good standing of their own National
Federation, 10) USEA beginner novice division; and 11) assistant handlers in Dressage
Sport Horse Breeding classes.